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“[H]ealth care system is coming apart at the seams….On the ground, there is too often a glaring lack of execution: long waits, bed shortages, unequal access to medication. Those failures are compounded by the fact that the ever-rising medicare bill is squeezing out education and other social priorities.”

No, that’s not from an item in the NewYorkTimes; rather, that’s from a piece in the Toronto Globe and Mail on Nov 7, 2010 about Canada’s health care system. Its problems provide a glimpse of what a fee-for-service medical care produces in a single payer system: no demonizing of insurance companies, no teeth gnashing about the uninsured, and no end to the concern about how to pay for health care. The Globe and Mail goes on to point out that most European countries have done what Canada needs to do: “Adopt a model that pragmatically mixes public and private elements both in funding and delivery…”

The conflict in Canada is over whether fairness means sameness, and whether everyone should get the same care under the same conditions or, as in most European countries, should a two-tier system be implemented. In these cases, those with more resources can get health care services without waiting and, on occasion, with enhanced ambience.

More by Stanley Goldfarb

There really is not a single Canadian system but rather a series of provincial systems each with its own approach to the issue. The series in the GlobeandMail is surprisingly, to borrow a phrase, fair and balanced. There are some abuses in the private system, where it is allowed, but there are major deficiencies in the public system because of growing demand for services. On the whole though, an 8 percent inflation rate in health care costs in Canada is unsustainable and having a single payer system is not enough to make the problem go away.

Paul Krugman, in a recent appearance on ABC’s “This Week,” boiled the choice for Medicare down to identifying what works and what does not. This is an economist’s view of health care and it is beyond superficial. As the Canadian system shows, central control leads to, for example, a one-year wait to have a colonoscopy in Quebec. It might make sense from an economist’s perspective, but the populace is not that happy about it and demanding better government care. (Krugman also conveniently avoids talking about what does not work with Medicare, relying instead to focus on the positive.)

So think again about a single payer plan. It is struggling in a nation with about 1/10 the U.S. population. Plan B is needed. Ideological arguments about how we need to eliminate insurance companies and do away with a competition-based system simply do not square with the results of the Canadian experience. Yes, the cost of care for the average Canadian on a per capita basis is much less than in the U.S., but the availability of services is also much less for all the “discretionary” services that Americans, and particularly seniors, have come to expect.

Americans have looked at what Obamacare offers and realized that while it may help a small fraction of the population that is uninsured or underinsured, the promise of government run health care, such as what the Canadians receive, is not appealing. A model that involves competition based on quality and service, that takes advantage of technology, and that places the decisions for care in the hands of patients and physicians, as each has an economic incentive to be highly efficient, is what is required. Moreover, the choice denied to most Canadians to spend more to receive the services they desire is a deficiency that America should avoid.

Barack Obama, and most of the progressive movement, has declared that a single payer system is the end game for health care reform. If they are successful, we’ll be seeing this sort of article in the New York Times pretty soon.